COMMENTARY

Chaotic and Failing -- Ethicist Cites COVID Vaccine Distribution

Arthur L. Caplan, PhD

Disclosures

January 14, 2021

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the New York University Division of Medical Ethics at the Grossman School of Medicine.

There are two particular examples of maldistribution of vaccine that I think are really bothersome, and they reflect a lack of federal policy, state coordination, and really just getting our ducks in a row for this very important allocation and distribution challenge.

Some states have said, "We're not going to vaccinate prisoners." Some states have not even thought about whether they want to vaccinate prison guards. This is ridiculous. Prisons are known hotbeds of infection. Hopefully vaccination will control infectivity. You must try to vaccinate at prisons so that you don't turn them into incubators of disease, with guards coming and going, visitors coming in and out, and people bringing food in and out.

We are in a situation, regardless of what you think about prisoners, where we have to be thinking about public health. To see public officials not called to account when they say, "We're not vaccinating prisoners because obviously it's politically unpopular and we're not going to do that" makes zero sense. It doesn't make sense in terms of getting a handle on these outbreaks and preventing deaths in places where, because they're jammed together and they can't really separate and distance or mask convincingly well, they're going to die.

The other outrageous example of failure of allocation policy comes right out of New York. Our governor was saying for a long time, "Get the vaccines out, use them or lose them, and it's going to be very important when we ship the supply to use it." He then flipped around all of a sudden and said, "If hospitals or nursing homes in the state are not following my guidelines, I'm going to penalize them." It's one thing to argue that we are going to have consistent policies and try to follow them and urge that. It's another thing to see policy change on a dime and be told one thing and then another.

We had a situation in almost every state, New York included, where vaccines shipped, the holidays came, and people took the days off. No vaccinations were taking place in many facilities on Christmas or New Year's Day. Are you kidding me? It's a plague 24/7. Let's go.

Don't worry so much about whether we are using the vaccine the way the governor told us on this list. Let's just make sure the vaccine sites are open, that people are told to show up, and if they do show up, there's somebody there to vaccinate them.

Again, public officials all around the country, I think, have failed us. They haven't set out consistent policies. They haven't coordinated their policies. They're letting people act as if, well, it's a plague, but if you need time off because it's a traditional vacation day, you just do that.

They're not allowing us to overcome our bias, prejudice, and feelings about people like prisoners, the disabled, or people who are institutionalized because of psychiatric illness, all of whom are exceedingly high-risk and can transmit disease, and we want to make sure that that doesn't happen.

And then they're sending mixed messages. "Vaccinate and use up everything we send. If you don't do that, you're going to get fined if you vaccinate people who aren't on our list." That's no way to give judgment and discretion to people doing vaccination.

I'm interested in what committees say. I'm interested in what the CDC says. I'm interested in what the Advisory Committee on Immunization Practices says. I'm interested in what the governor says.

I'm most interested in what's going on on the front line in a facility in New York, Florida, or California, when judgments have to be made under specific circumstances and often under duress because people aren't there, there's too much vaccine, people are refusing, or they sent too much. You can't regulate that from Washington or the state capital. You've got to give some discretion to local judgment.

We're not doing the job we should on allocation. We need to do a much better job in terms of protecting the most vulnerable, making sure we control transmission as best we can, not taking a day off, and certainly not sending mixed messages about who to vaccinate and who not to vaccinate.

I'm Art Caplan at the Division of Medical Ethics at the New York University Grossman School of Medicine. Thanks for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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